acyclovir and Cerebral-Infarction

Herpes zoster ophthalmicus can be complicated by a delayed ipsilateral cerebral angiitis which may cause infarction and a smoldering meningoencephalitis. We describe such a case treated successfully with steroids and acyclovir. It is important to consider the diagnosis of this disorder early since therapeutic intervention may prevent an otherwise high morbidity and mortality. Steroids may have to be continued for some time after clinical resolution, using the ESR as a guideline for decreasing dosages.

Topics: Acyclovir; Aged; Cerebral Infarction; Female; Herpes Zoster Ophthalmicus; Humans; Meningoencephalitis; Prednisone; Vasculitis

A 14-year-old girl developed transient disturbance of consciousness, dysarthria, and clumsiness of the right upper limb 4 months after herpes zoster ophthalmicus. Brain MRI showed acute cerebral infarction in the left middle cerebral artery (MCA) territory. CT angiography demonstrated mild stenosis in the top of the left internal carotid artery and the proximal side of the MCA. Cerebrospinal fluid (CSF) examination showed slightly mononuclear pleocytosis (6/μl). Titer of the anti-varicella zoster virus (VZV) IgG antibodies in CSF was increased, and gadolinium-enhanced brain MRI (T

Topics: Acyclovir; Adolescent; Antibodies, Viral; Antiviral Agents; Biomarkers; Brain; Cerebral Infarction; Drug Therapy, Combination; Female; Fibrinolytic Agents; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunoglobulin G; Magnetic Resonance Imaging; Methylprednisolone; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Valacyclovir; Valine

Ischemic stroke is a recognised complication of Varicella-zoster virus (VZV) infections. We report on an otherwise healthy four-year-old boy who presented with acute neurological symptoms due to cerebral infarction eight months after primary VZV infection. Magnetic resonance imaging showed an infarct located to the left nucleus lentiformis. The patient was treated intravenously with aciclovir and steroid. With this case report we underline the importance of looking into the history of VZV infection when children present with prolonged neurological symptoms.

Topics: Acyclovir; Antiviral Agents; Cerebral Infarction; Child, Preschool; Encephalitis, Varicella Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male

We report the case of a 52-year-old immunocompetent man with varicella-zoster virus large-vessel vasculopathy and multiple bilateral cerebral infarcts who had no history of skin involvement. Etiologic diagnosis was made by isolation of varicella-zoster virus from a cerebrospinal fluid specimen. The patient had marked improvement in mental status after acyclovir therapy was initiated.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebral Infarction; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Skin

Delayed central neurological symptoms following herpes zoster ophthalmicus (HZO) such as "herpes zoster ophthalmicus and delayed contralateral hemiparesis" are considered to be due to ipsilateral intracranial vasculopathy. We experienced a rare case with cerebral infarction occurred in puerperium following HZO in late pregnancy. A healthy 30-year-old woman had left HZO at weeks 35 of gestation. She was given acyclovir (ACV) for external use and improved with small pigmentation on the left eye-lid. Seven weeks after the onset of HZO, she suddenly developed aphasia and right hemiparesis. Cerebral angiogram showed narrowing on M 1 segment of the ipsilateral middle cerebral artery. The occlusion was seen on peripheral portion of the angular artery on the same side. In cerebrospinal fluid (CSF), cell count was slightly elevated, but concentration of protein and sugar were normal. Varicella-zoster titer was increased in both serum and CSF. She was treated with intravenous ACV (1500 mg/day) for 10 days. On the next day after the treatment, the cell count was normalized and on 18th day, varicella-zoster titer was decreased in CSF. Higher brain function improved and no relapses occurred. This is a first case of delayed cerebral infarction occurring in puerperium preceded by herpes zoster ophthalmicus in late pregnancy, as far as we searched. We should treat carefully pregnant or lactating patients with HZO, considering delayed cerebral infarction.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebral Infarction; Female; Herpes Zoster Ophthalmicus; Humans; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Puerperal Disorders

A 61-year old man with a history of arterial hypertension suffered a left HZO, and was treated with acyclovir. Three weeks later he suddenly developed moderate left hemiparesis particularly of the leg, severe paresis of the right leg, aphasia and somnolence. Treated with IV acyclovir and high-dose corticosteroids deterioration of the right hemiparesis was apparent. Serological and CSF-studies showed acute varicella-zoster virus infection with intrathecal antibody synthesis (antibody specificity index 2.7). On the third day CT scan revealed infarctions in the territory of both anterior cerebral arteries, at the fifth day additionally left striatocapsular infarction. Selective carotid arteriogram showed bilateral occlusions of anterior cerebral arteries in their proximal segment. With a mean delay of seven weeks granulomatous vasculitis is a rare complication of HZO, leading commonly to ischemic infarctions in the region of the middle cerebral artery. Trigeminovascular connections are the probable pathway of virus-transmission from the trigeminal nerve to ipsilateral branches of the circle of Willis. Because of the presumed pathogenesis immediate therapy with high-dose corticosteroids and acyclovir is justified.

Topics: Acyclovir; Antiviral Agents; Arteritis; Cerebral Angiography; Cerebral Arterial Diseases; Cerebral Infarction; Dominance, Cerebral; Follow-Up Studies; Granuloma; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Tomography, X-Ray Computed

To present a case of cerebral infarction following thoracic herpes zoster presenting as Gerstmann's syndrome.. A 61 year old male developed herpes zoster of T 1-2 dermatomes. Four months later he developed a confusional state together with expressive aphasia, dyscalculia, dysgraphia and finger agnosia with no long tract signs. CT scan of head showed recent infarction of this left parietal lobe. He received a five day course of acyclovir 800 mg four times daily and showed slow but steady improvement.. Herpes zoster is uncommonly followed by cerebral infarction. Acyclovir may have a role in therapy of this complication.

Topics: Acyclovir; Cerebral Infarction; Gerstmann Syndrome; Herpes Zoster; Humans; Male; Middle Aged

A 57-year-old patient nonimmunosuppressed who had zoster ophthalmicus associated to contralateral hemiplegia is presented. We noticed on the CT scan an infarction of left caudate nucleus, as well as in the angiography signs of vasculitis. We comment on the clinical and diagnosis features and suggest possible benefit effects of the treatment with acyclovir.

Topics: Acyclovir; Brain; Cerebral Infarction; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Tomography, X-Ray Computed

Topics: Acyclovir; Adult; Cerebral Infarction; Dexamethasone; Ear Diseases; Herpes Zoster; Humans; Male; Tomography, X-Ray Computed

Four patients with herpes zoster ophthalmicus and delayed contralateral hemiparesis are described, and their findings are compared with those in patients previously reported in the English language literature. The current patients evidenced multifocal ipsilateral cerebral angiitis by angiography and multifocal infarcts in the distribution of the ipsilateral middle cerebral artery by computed tomographic scanning. Cerebrospinal fluid showed mononuclear pleocytosis, positive oligoclonal bands, and an elevated immunoglobulin G index. Two patients were treated with corticosteroids and acyclovir, and 1 with corticosteroids alone, all without apparent response. Necrotizing angiitis ipsilateral to the herpes zoster ophthalmicus was demonstrated postmortem in 1 patient with multifocal cerebral infarction and progressive leukoencephalopathy. Neither herpes varicella zoster immunocytochemical reactivity nor viral inclusions were seen. The leukoencephalopathy associated with herpes varicella zoster either may be caused by cerebral angiitis or, as previously reported, may be a temporally remote manifestation of persistent herpes varicella zoster infection. The cerebral angiitis associated with herpes varicella zoster is histologically similar to granulomatous angiitis, and both may be related to herpes varicella zoster infection of the cerebral vasculature.

Topics: Acyclovir; Aged; Brain; Cerebral Arterial Diseases; Cerebral Infarction; Dexamethasone; Dominance, Cerebral; Electroencephalography; Female; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prednisone; Tomography, X-Ray Computed; Vasculitis